The Health and Work Service
- Scotland, UK
Dr Alastair Leckie
Consultant in Occupational Medicine
OHSAS
Medical advisor to Scottish Government
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Background
History of Scottish service
How service will be delivered in Scotland
Milestones
How you might contribute
Q&As
The Service will use a supportive, biopsychosocial approach with
case management follow up to help ensure individuals return to work
as quickly as appropriate. Individualised Return to Work Plans
(RtWPs) can be used to replace fit notes as evidence for sickness
absence for the duration specified in the plan.
Evidence of
sickness
absence
7 day selfcertification
period
Other evidence*
Other evidence*
GP fit note
Return to Work Plan
Employee on sickness absence
Referral
by GP
Employee
journey
Employee
goes on
sickness
absence
HWS
RtWP
Assessment produced*
Referral
by employer
4 weeks absence
Case Management
Return to
Work
Discharge Follow
up
6 weeks absence
*the RTWP will be provided for the employee and shared with
the GP and/or employer, with the employee’s consent.
The Health and Work Service will be
delivered across Great Britain, with a unified
brand and scope
England & Wales
- External procurement
- Health Management Ltd
Scotland
- Agency agreement with Scottish Government to
deliver on behalf of DWP
Overall
- Same service & outputs across GB
Programme In Scotland
• Programme Board
• Implementation Group
– AdviceServices, Website & Advice Line – NHS24 &
SCHWL
– Enrolment – NHS 24
– Assessment & Return to Work Planning – Salus
• Medical Advisor
• Stakeholders
• Additional Advisors, e-health, marketing, Expert Panel
Glasgow Uni, finance, legal, project management etc
DWP
Management Group
Medical Advisor
National Manager
(Contract
Management/Whole
Service Overview/Quality
Assurance)
Assessment
Service
Regional Hub
NHS Boards
Case
Managers
Assessors
Regional Hub
NHS Boards
Case
Managers
Assessors
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IT
Advice
Services
Enrolment
Supervisor
Quality
Assurance
Call Operators
Website
Health
Information
Officers
Advice Line
Manager
Call Handlers
Occupational
Health
Advisors
A
SERVICE Health & Work Service
Face to face - appointment made within 2 days,
Follow up
Questionnaire/
Tel call to
check outcome
for evaluation
First assessment within 5 working days
All telephone assessments within 2 working days
Discharged
Employer checks eligibility & makes
referral to H&WS after 4 weeks absence
(7)
Individual attends
nd
GP for 2 Fit Note
GP checks
eligibility &
completes
information,
including
consent and
record is
passed to
H&WS
GP assessment,
recommends
referral to H&WS
(1)
Appt is made
with specialist
advisor for face
to face
assessment (4)
**(9)
(1,908)
HWS calls
Individual &
checks
consent,
eligibility and
basic
demographics
are completed
(2)
(5,300)
HWS logs
details
and date
of receipt
Eligible
?
No
Return to referrer with
response returned (3)
RTWP shared
with
employer/GP
(8)
Yes
Appt
req?
No
Yes
Appt
req?
No
Individual is
transferred to
specialist
advisor on tel (4)
**(9)
ADVICE LINE
WEBSITE
Employee/employer
/GP Calls Advice
Line
Individual is taken
through
biopsychosocial
assessment (5)
(47,700)
More intensive tel
or face-to-face
assessment takes
place (may not be
the same specialist
as initial
assessment)
No
Further
assessment
required?
(max. 3)
Yes
Arrange time/date
for assessment (6)
CASE MANAGEMENT THROUGHOUT PROCESS
Employee/employer
/GP Visits Website
Max 3 – RTW not
feasible at this
time
All RTWP
shared
within 2
working
days of final
assessment
Consent agreed
to share with
GP/employer
RTWP
drafted/revised
Employer
Completes
Electronic
referral
Yes
Yes
RTWP shared
with
employee (8)
Max
3
Advice report
provided for those
who cannot have a
RTWP agreed but
still need support.
(10)
Key Issues/Milestones
• Go Live on 15th December 2014
• Phased introduction with full service by March 2015
• Estimated volumes running at estimated potential 50k
employees per annum
• Clear criteria and service specification
• Assessment & advice – not funded for intervention
• Telephone based model
• Scottish Service – expansion & redesign of WHSS
• Performance managed by DWP to same standard as
England & Wales
To April 2015
Assessment service
Low
High
April 2015-16
April 2016-17
Low
Low
High
Estimate Referral Range
p.a.
2500
5000
Assumed invalid level of
8%
200
400
800
1600
2400
4800
12
24
48
95
143
286
Estimate cases/day
60% dealt with at initial
assessment (p.a.)
1000
0 20000
High
5520 11040
3000
0 60000
1656
0 33120
1380
2760
Estimate assessments/day
7
13
26
53
79
158
No. of case managed/day
4
9
18
35
53
105
Face-to-face
assessment/day
1
2
5
9
14
27
Call handlers @ 30
calls/day
1
1
2
3
5
10
Assessors @ 6 cases/day
1
2
4
9
13
26
Case managers @ 4
cases/day
1
2
4
9
13
26
How can you help?
• Questions now
• Engage with your employers/OHDs
• Work out how you are going to engage
with HWS
• Identify any issues
• Share issues today
• Share solutions today!
Existing OH
services
HWS
Existing GP
service
Employer +/- self
GP +/- employer
None
Services
Employer
driven/agreed
Sickness absence
assessment
Sickness absence
assessment
Point of
involvement
Employer
driven/agreed
@ 4-6 weeks
GP/patient driven
agreed
Employer
driven/agreed
Maximum of three
times
Referral routes
Frequency of
contact
Workplace
knowledge
Good
Duration of
involvement
Employer
driven/agreed
Quantity of
involvement
Employer
driven/agreed
Employee
information +/employer
information
3 months
compulsory
discharge
1 per annum
GP/patient driven
agreed
Employee
information
For ever
Unlimited
Interaction between HWS and OH
• Very similar to current fit notes
• RtWP may suggest OH involvement
• RtWP can be amended to include further
information from employer or their OHS
• OHS may take over
Answers?
Employers
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Input to service
Adjusting SA policies
Information gap
Practical issues re contacting service
RTWP input
Certification (legal standing)
What does employer get
Who is responsible for action on advice
Employers more
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Workplace knowledge
Signposting
Current OH provision
Tax relief
RTWP before assessment completed
Consent
OH
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Fit with existing OH provision
Conflict of advice
Disinvestment
Resourcing small number of OH
professionals
• Who will deliver
Marketing communications
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Key messages
Detailed description of service
GP engagement
Employer engagement
Long term conditions
• F2f assessments
• Support for mental health
2nd workshop
• Engagement
1. Employers and HAWS
2. OH and HAWS
• Marketing/information